Working to change our understanding of mental health disorders and the approach to treating them.
Working to reduce stigma and promote acceptance.
Teaching positive ways to a better life and mind, to a better mind and life.

Sunday, October 4, 2015

An Introduction to Mindfulness Meditation Cognitive Behaviour Therapy

As
I put more and more distance between my present self and the self
that went through the worst of what many consider to be the most
difficult to deal with psychiatric disorder (bipolar type I) along
with major anxiety disorder and borderline personality disorder along
with being homeless through a Canadian winter, I can look back with
some added perspective as to how I not only managed to get through
all of that but actually continue to handle my mental outlooks,
moods, mental states, cognitive abilities, abilities to handle life's
difficulties and so on in a much improved fashion.

I
have to be clear that one does not - at least at my age and for how
long my brain has been a "bipolar brain" (and all the rest)
- simply "stop" being bipolar. Those potential forces are
and will always be there, they always must be managed. A bipolar
brain (the real ones, not the tragically misdiagnosed ones) is always
going to be prone to certain reactions to life's stress and stressful
events. It is never going to be easy to manage. There is always going
to be potential for being blown way off the rails by life events and
stressors outside of one's control. This is true of all long term
disorders.

Reflecting
back, there was certainly no one magic bullet or even strategy that
made the difference
in learning to better manage the horrors and intense emotions and
reactions my mind could produce so I need to think hard on what
exactly made the biggest differences (aside from the basics of
my Positive
Difference Making Fundamentals).

In
various previous posts, I've talked some about thoughts and the power
they have over us and while there is certainly more than just
thoughts involved with major psychiatric disorders, there's no
denying that how our thoughts are generated, what thoughts we have,
and the directions our thoughts will steer our minds and lives is a
very significant factor driving mental states and moods.

Aside
from thoughts are our "instinctive" reactions to life
events, triggers, others' words and actions towards us and so on but
even many of our own reactions arise out of our own thoughts, mental
models and ingrained thought processes. (I'm going to have to leave
reactions for a future post, and it is when we begin to study our
reactions and how and why we react certain ways that understanding
just how very autonomous our subconscious "zombie
programs" are
will really come to the fore).

And
of course tied to both our reactions and thoughts are our
emotions.

So
I'm going to go ahead and declare that it's a pretty safe bet that in
rearranging my mind, moods, reactions, impulses and so on to create a
more mentally stable, emotionally resilient and healthy me, learning
to deal with my thoughts ranks pretty close to the top of the list of
how I turned so many things around.

Now,
if someone had told me during the worst of my mental states that it
was "just thoughts", I'd have been the first to freak out
and scream "this is more than just thoughts!!". And my
experience at the time was that it certainly seemed to me much more
than "just thoughts". It felt for all the world that I was
in the grips of something very, very powerful (and in a very real
sense, I was). However, as I learned more and more about the
neuroscience of thoughts and the power of thoughts and how thoughts
could cascade into creating
the stress
and anxiety and
resultant stress response system spikes that were causing my worst
melt downs, I had to begin to admit to myself and come to accept that
so much of what was driving my mental states was thoughts and their
power (and I think I'll need several more key posts to further
convince you the readers of the power your thoughts have over you),
the question became how to control them.

Thoughts,
as I'm sure many of you who battle mental health disorders are aware,
don't just go away because we ask them to. If only it were so simple.
Thoughts are all generated by specific brain regions and networks
(neuronal groups and the wiring networks that connect them, something
I introduced in Chapter
One - Neuroanatomy 101 and
in this
post introducing neuroplasticity)
and it is part of our disorders that these "brain loops"
(as I like to call them) become too dominant and ingrained in our
overall brain functioning.

Changing
our thoughts, therefore, means changing brain regions and brain
wiring, something that is known not to be easy. I liken it to a
professional golfer trying to change his golf swing, even someone as
great as Tiger Woods. To learn the new swing they have to also learn
to "forget" the old swing for it is the old swing (which
they are changing because it is now producing poor results) that will
just naturally and automatically come back when they step up to a
ball and initiate a swing. And they have to "overwrite" the
old swing with a lot of conscious effort and repetition of the new
swing. It's difficult because it requires breaking down old wiring
networks and building new ones (this is what neuroplasticity is all
about, folks). Even for a great athlete with top notch coaching it
takes a great amount of work.

And
it is exactly the same with thoughts, emotions, reactions and behaviours that could arise from those; like breaking any old habit we
no longer want and building new habits, it takes a lot of conscious
effort to be aware of what is now undesired, what we want to replace
it with, and the efforts to implement and ingrain the new habit.

The
trouble with something like thoughts or emotions is that they have been so much a
part of us, and likely so much a dominating part of
us, we're hardly aware that they're even there, much less how much
power they have over us and the damage they are doing to us. And
we're almost certainly not aware that they don'thave
to be there and dominate our minds and lives so much.

As
I've said numerous times previously in this blog, I stopped at
nothing and investigated everything in looking at how to recognize
and deal with mental health disorders of all kinds. As well, I
attended and took part in several kinds of therapy and group therapy
(including being introduced to the very excellent Core
Program (1))
so in several different ways and through several different sources
and at different levels, I came to understand Cognitive Behaviour
Therapy and mindfulness meditation and somehow, though I no longer
precisely recall how, the subject of this post - Mindfulness
Meditation Cognitive Behaviour Therapy.

I
was actually practicing this before I came across the term, read what
it was about and realized, "oh, that's what I've been doing"
but understanding better what I'd already been doing did help me to
improve my practice of it. I'll get to how we're going to approach
the practice of <deep breath> mindfulness meditation behaviour
therapy in a minute but first let's break it down and remove some of
the mystery and what I'm going to assume is a bit of an intimidation
factor.

Mindfulness
Meditation has
its roots - of course - in meditation, a mind training practice that
itself originated in Hinduism and Buddhism healing and spiritual
practices nearly 2,500 years ago. Mindfulness meditation - to quote:

relies on techniques of mental training that suggest non-judgmental awareness of here-and-now mental or somatosensory* experience positively influences accurateness of perception and acceptance of one's own life experiences. The mindful practitioner thus amalgamates a focused attention component with a non-judgmental attitude of openness and receptivity when trying to pay attention to and non-reactively monitor the content of present-moment experience.

[*
"somatosensory" is a term which in this context
distinguishesphysical experiencefrom mental experience]

Cognitive
behaviour therapy is
a form of long standing and often very successful psychotherapy that
arose out of combining the principles of cognitive and behaviour
therapies. Cognitive refers to our thoughts and mental patterns, and
behaviours to our reactions to life around us or the actions we
habitually take. CBT is designed to help us work through our
thoughts, behaviours/actions, and feelings (emotions) and to
understand their relations to each other within us. Its goal is to
help us gain more control over all three aspects and to hopefully
build more optimal thoughts, behaviours (or actions/reactions) and
emotions that are more adaptive to our life situations. It is
designed to bring these all into more harmony within us - which, I
can assure you, can go a long ways in settling down a great deal of
the inner turmoil and conflict we experience and which has such an
unsettling effect on our overall mental states and peace of mind.

This
illustrates what we were looking at above - how our thoughts,
feelings/emotions and behaviours/reactions all tie together. I early
on recognized the benefits of CBT, however the trouble was that I in
no way could afford a one on one therapist skilled in teaching and
applying CBT. Group therapy can be effective but the problem is
finding a good group that is affordable and within convenient
distance of where one lives.

For
the vast majority of those suffering mental health disorders, finding
therapy of any kind, let alone therapy that is
personalized and effective is extremely challenging,
if not downright impossible.

Which
is the situation I faced - I not only could not find therapists
trained and able to deal with my complicated and difficult case (2),
in no way could I have afforded it even if I could (though again, I
did find some groups at various times which were beneficial in some
way or another at the times).

So
what to do?

I
very early on in my race to discover ways to manage or overcome
mental health disorders starting at the beginning of 2013 began to
come across many ties between the study of the brain and meditation,
chiefly that meditative practices could change the brain in very
important and positive ways. As I started looking more into
meditation, I came across the concept of mindfulness meditation. As I
was already studying the neuroscience of consciousness and various
means of "altering" consciousness, I grasped the
fundamentals of mindfulness meditation quite quickly but at the same
time I could see and sense this gulf between how "normal"
practitioners practiced it and how we peeps with poor mental health
could utilize it. This is a beef with me with meditation and yoga;
two very useful practices made overly complicated, too advanced and
difficult for the majority of people to gain from.

So
setting aside all what you may have read or learned elsewhere about
mindfulness meditation, I'm just going to get to how I combined
mindfulness meditation and CBT and further, how I learned to do them
on my own without too much complication and difficulty.

To
better understand how I approach mindfulness I'm going to ask that we
have another brief look at consciousness. Regular readers will recall
that we looked at consciousness in the previous posts An
Introduction to Meditation and On
Consciousness, Thoughts and Meditation.
In those posts I likened consciousness to our computer screens and
speakers and just as those peripherals display only a small portion
of what your computer is capable of (through its own programs, memory
stored and what it can bring in through the Internet) for you to work
on at any one time, consciousness is like a "screen" or
"working plate" created by our brains at any one time out
of all of what our brains are capable of producing through our
senses, our brains' programming and the vast amounts of memory stored
there.

It
is also necessary to recall that our brains often, or maybe always,
don't give us much choice of what is put up on our "awareness
plates" or consciousness. It is also necessary to recall that
our brains keep vast amounts of inner activities outside our
conscious awareness (and thus we're not aware of what's causing so
many of our behaviours that are driving us batty and which we'd like
to change).

So
we're going to learn how to better manage our "conscious plates"
or "conscious computer screens and speakers" and we're
going to do that with mindfulness meditation, or at least my version
of it. And with mindfulness meditation, we're going to tie it in to
CBT and thus learn how to better manage our thoughts, behaviours, and
feelings/emotions.

I
must tell you up front that this is no small task. I said above that
I learned how to do it without too much complication and difficulty
but by that I mean the actual practice of it needn't be complicated
or difficult. This does not mean, however, that the mental work we
must do is easy. We need to be aware of that and understand that it's
not going to be easy because if we do that, we are less likely to
become discouraged when we find that it can be tough. We are far
better able to cope with difficulty (generally) if we know up front
what to expect and how to deal with it (and we'll be learning
techniques and the belief that we can deal with it).

Now,
without further ado, here we go.

I
think of mindfulness meditative CBT as a time set aside to
specifically examine my thoughts, feelings and ongoing events in my
life. I also think of it as a way to let my mind to slowly wake up in
the morning in ways that I am paying close attention to.

Mindfulness
CBT takes a certain amount of bravery when you have the sort of
thoughts that come with psychiatric disorders like bipolar and
suicidal depression so let's keep that in mind as well. And with that
in mind, lets just go ahead and give ourselves permission to be
brave, to believe that we can do this, even if for only a short
period of time each day. And like other forms of meditation, it is
quite alright to do it only for short periods of time to
begin with. I certainly started out with short periods but after I
began to make some noticeable headway, I found I could stretch out
the time I did mindfulness CBT longer and longer.

I'm
a morning person so I do mine first thing in the morning when
everything is quiet and we do want quiet, undisturbed time to do this
(and I realize what a challenge this is for many, especially for the
parents out there among you). Let's assume though that we can find
some quiet time.

Now,
here's what we're going to do - and this is the scary part - we're
going to allow all and any thoughts to come into our consciousness.
But - and just for this period of mindfulness CBT - we're not going
to judge them, we're not going to try push any aside; we're going to
allow them to come in. But because we put ourselves in a brave state
of mind and we're in a safe quiet place, this is going to be okay, if
only for a short period of time.

If
you're like I was (and can still sometimes be), you're going to have
an enormous number of possibly very disturbing thoughts vying for
attention. But we're not going to pay attention to any particular
thoughts just yet. And we're going to think of our mind like our
computer screen metaphor and our thoughts as things that are popping
up on that screen.

As
we saw above, the point of CBT is to learn how to examine and deal
with our thoughts, behaviours and feelings (along with core beliefs
and values), but today we're going to look at and just focus on
thoughts, though we're also going to start examining the emotions that can come with our thoughts. Our minds can produce a lot of thoughts, in our
cases often of the nuclear grade negative variety, so
obviously dealing with our thoughts is an overwhelming and
frightening sounding proposition. But again, we're going to give
ourselves permission to be brave about this. And we're going to start
to learn the concept that whatever our thoughts are, they are just
thoughts. This will be very hard for many of you (and it certainly
was for me) but again, for just this brief period of mindfulness CBT,
that's how we're going to think of them.

Now
- and here's the important part - we cannot deal with all our
thoughts at once; this is a big part of what drives us crazy, after
all. So what we're going to do is to now begin to pay more mindful
attention to our thoughts. We're going to lie here quietly and just
sort of see what thoughts are going on.

They'll
be swirling around, each trying to push the other aside. Or as one
reader referred to it in a comment at the end of the post talking
about bipolar and empathy (and
empathy in general), the "blender in my head". Through
this tornado of thoughts, some are going to start to be more
dominant. So what we're going to do is pay attention to the dominant
ones and we're going to choose just one or two.

Now,
if I can get you to imagine your mind as being like that computer
screen metaphor of ours, this is what we're going to do. You're going
to imagine that our thoughts are like the tabs and various programs
on your computer screen and that you have a mouse in your hand. Now,
with that mouse, you're going to start "clicking" the "X"
on the "tabs and programs" of thoughts to "close"
the thoughts and feelings we don't want to look at just now.

So
we've chosen a thought or two we want to examine more closely and all
the others we're going to "close" in our mind, just like
closing tabs, browsers, photo images or whatever else we might have
open on our computer screen at any one time so that we can focus on
just a few things without other distractions or bogging down the
computer speed.

This
will not be easy at first. Like pop-up ads, many of these unwanted
thoughts and images are going to pop up again again and again as soon
as we close them. But for this period of Mindfulness CBT we're going
to be persistent, just stick with it and mentally just keep
"clicking" on them and visualize them disappearing from
your inner screen.

I'll
ask you to just imagine that for a few moments - clicking on unwanted
pop-ups and tabs and so on and closing them. Now imagine doing that
with thoughts in your mind and having the same power to close them.

Now,
let's focus on the few thoughts we've chosen (and here's where
general meditative practice begins to pay off - when we chose to
focus on one or a few things and disregard others, those others will
begin to naturally fade into the background). These thoughts we chose
could be about anything - anything. They might
be how we think of ourselves, our bodies, our situations. They might
be about our jobs and money. They might be about our future. They are
undoubtedly scary and worrisome. But, for this time at least, we're
not going to feel afraid of them.

I'll
also ask at this time to please bear in mind that this takes practice
and the first attempts will probably not go well. And that is
perfectly one hundred percent okay and normal and I'll ask as well
that you give yourself permission to forgive yourself if you don't
nail it on your first try.

Okay,
so now we have a thought or two to examine and we're going to start
questioning the ones we've chosen. There's quite a process for this,
and I'm going to have to write a separate column for how this works,
but I want for now to start with this idea and process of questioning
our thoughts. I want to start with the idea and process of
questioning whether these thoughts really have to be
there at all, I want to start with the idea and process of
questioning the very truth of these thoughts and
ideas that are plaguing our minds and lives.

As
an example, let's start with a very common one - that we're ugly,
we're bad people and nobody wants to be around us and that everyone
hates us. For this time, during our mindfulness CBT session, we're
going to challenge the truth of these thoughts.

This
will be very, very hard for many of you. For these thoughts have been
so much a part of our inner landscape that they have become an
"undeniable truth". Furthermore - and this is a "buggy"
way the human brain works - when we get a "truth" like this
in our minds, our brains will actively search for "evidence"
to support these "truths". But for now we're going to
question that.

And
to do this, I want you to actually question them. Try it! Just ask
yourself, "Hhmmm, is that really true?"
And of course your mind will immediately leap to provide all kinds of
"evidence" that of course it's true. But we're going to be
very stubborn here. We're going to keep pushing back on these
thoughts and "evidence". Let's start with something easy
like "nobody likes us". Really?? Nobody?? Nobody??
Not a single solitary person on the whole planet likes us? Seven
billion people on the planet and not a single one likes us? Really??

Now,
if we start questioning this and asking if this is really true, we
may well find that it's not. If we start thinking through it, we may
find that it's not as true as we thought. Now it may be true that we
may not exactly be popular, but we'll find that it's not exactly true
that "nobody" likes us.

So
we'll just go ahead and focus for a few moments on thinking of people
who like us, or who don't mind us too much or even, to start with,
who don't "hate" us. It might only be one. It might be
five. It could be any number. What we want is to see evidence that
counters our "belief" that "nobody" likes us.

Now,
as we examine the truths of our thoughts, it's also important to
learn acceptance of some of our more unpleasant thoughts and truths
behind them and - AND - to take ownership for them.
Very, very, very important. For when we learn to
take ownership of something, we give ourselves the
power to do something about it. And if we have that power, we can
change it.

So
now that we have identified a thought we don't like, and furthermore
the basis for that thought and what's true and not true about the
basis for it, let's try to think of some simple daily courses of
action for what we can do about it. If we are troubled by feeling, or
perceiving, that we are not popular, what are some daily actions we
can do to change that? (I'll let you think on this for yourself, as
exploring this will quickly stretch the boundaries of this post too
far). Just remember the formula above in that thoughts and supporting
behaviours must be in alignment so we must create better behaviours
that will support our better thoughts and better thoughts to create
our better behaviours.

We
can also use this time as an opportunity to start working on black or
white thinking and the belief that everything has to be painted in
stark either/or colours such as someone either "likes" us
or "hates" us. We can start to think that maybe there are
all kinds of shades or that there are different aspects to how people
feel about us. Maybe they like us in this way but not so much in that
way.

We
can start to question the black and white thinking about our very
selves. Are we really "bad" people or maybe we're just bad
sometimes? Maybe we're not "bad" but just do bad things
sometimes.We can start to separate "us" from our behaviour
(a classic therapy technique).

And
so it will go as we look through and examine our thoughts and
feelings about and reactions to our mental states and experiences of
the world around us.

We're
not going to turn around our thoughts, feelings about any one aspect
of ourselves or our reactions to the world around us in one session
but we're going to start chipping away these long held "truths"
about ourselves, these thoughts and ideas about ourselves that we are
just convinced are "self-evident". As well, we're going to
start learning more about common
cognitive distortions and
working through those.

And
more importantly, we're going to start establishing the habit of
creating the time and mental space to work on mindfulness meditation
CBT. Way back when I wrote out my positive difference making
fundamentals, I wrote that I worked on creating better habits. This
is one of those. This was perhaps the most important
new habit I created.

For
as I've written before, if we don't learn to work on our thoughts, to
change our thoughts, we will be their bitch;
they will mess us up.

So,
before I go, a brief recap of what makes up mindfulness meditation
CBT:

Mindfulness:
This simply means paying mindful attention to what we are doing and
in the case here, paying mindful attention to our thoughts.

Meditation:
This is a tool we use to channel our focus on to specific things.
Practicing simple meditative techniques like those in an
introduction to meditation.
We use it in practicing mindfulness in the sense of to what we are
mindfully paying attention.

Cognitive
Behaviour Therapy: These are methods and tools for changing our
thoughts and behaviours. It is generally done with a therapist
working with you - and this is great if you can find one who's good
(not a given) - but we're going to start learning how to do it on our
own.

Method:
set aside periods of time each day that are quiet and you will not be
disturbed to allow yourself to mindfully examine the thoughts and
beliefs that are predominant at any one time. Learn to question the
truth and validity of these thoughts and beliefs. Learn to reframe
them. This time of mindfulness CBT can be just a few minutes to
start, up to half an hour, an hour or more.

Lastly,
I want to remind that this is not easy work. But then again, nothing
worthwhile doing is going to be easy. Now pay attention to that word
"worthwhile". Many of us will have issues with this idea of
"worth" and being "worthwhile", for one of our
dominating thoughts and ideas are probably that we're not "worth
it".

So
here's a little bit of homework for you today. Practice believing
that you are worth the work. Yes. You are
worth it. Yes. You. Are.

(1)
While I'd come to see the Core Program as an excellent resource,
unfortunately the facilitator I had leading the 8 week therapy
program was very poor and I gained little from it at the time. That
said, many of the things I'd learned I'd later see I'd begun to
subconsciously use, so I think being exposed to it despite the poor
facilitator made a difference in the long run.

(2)
At one point from the fall of 2012 into the spring of 2013 I was
extremely fortunate to work for free with a therapist who
specialized in suicidal danger through the University of British
Columbia's psychology program (the sessions and the relationship with
that therapist in training ended, however, with the end of that
school term). Though I'd been told I was welcome to register for free
therapy again the following fall, when I tried to do so I was told
that because my case was so difficult they did not feel comfortable
having me see any of their therapists.

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6 comments:

Some very well thought out ideas. As a meditator of 40+ years I really like what you said about questioning our thoughts of negative self-worth like I am ugly. I would just add I think questioning all thoughts is important. Thoughts are just thoughts not reality.

This is one of the most valuable, important pieces you have ever written. I am here to testify as your 'student' that if you put in the work, the results are more than worthwile. And I thank you, for your work, for being here.

About Me

I study neuroscience, cognitive neuroscience, human behaviour and certain neuropsychiatric disorders. I am currently working on a book summarizing much of what I believe are the most relevant brain abnormalities involved in neuropsychiatric disorders along with my own views and considerable insights.

Aside from that, I continue to pursue photography. Currently, I am working on a project involving female faces and various shapes and colours that I find interesting. Some of my previous photography is up on my website. Only a tiny fraction is up on the site (because of <ahem> "hard drive issues") but it gives some idea of what I do with a camera and the right lenses.

These two pursuits, along with great interests in music, cooking and baking, looking after Mrs Bean (and she after me) and following various sports (particularly baseball) keeps me more than busy enough.